Pilot grounded by his kidney stones Is there a legal use for steroids? CT scan report raised questions

February 06, 2008

HEALTH MATTERS DR. PAUL DONOHUE Q. I am a 46-year-old pilot with kidney stones. Consequently, I have been grounded. There is a small stone in both my right and left kidney. My local urologist and a urologist at Mayo Clinic advocate lithotripsy. I have concerns about lithotripsy because of a Mayo Clinic report linking it to diabetes and hypertension. I am looking for the safest and best option. What do you say? A. Extracorporeal shock wave lithotripsy, ESWL, dissolves kidney stones by pulverizing them with sound waves. The procedure is particularly successful with small stones like yours. Doctors at the Mayo Clinic did publish a paper that suggested lithotripsy might be associated with the development of diabetes or high blood pressure in a few people. You have a Mayo Clinic doctor who's suggesting the procedure to you. ESWL is still being carried out throughout the world. If I were a pilot wanting to get back to work, I'd have this done in a New York minute. (I'm not positive how long a New York minute is.) Q.What most Americans know about steroids is their illegal use, particularly by athletes, whose reputations are then ruined. Is there a legal use for steroids? Or are steroids primarily for building strength and power? Could they be a miracle cure? A."Steroid" is the name given to many hormones that share a common chemical structure. The various steroids, however, have completely different actions and are used for completely different conditions. One family of steroids is the cortisone family, and prednisone is one of its most popularly used members. The cortisone steroids are powerful anti-inflammatory agents and are used to treat many illnesses. Male sex hormones -- testosterone being one example -- are also steroids. They have no anti-inflammation properties. They also are called androgens or anabolic steroids. They promote muscle growth, and they also enhance male characteristics, like the pattern of body hair growth and the deepening of the voice. They have a legitimate place in medicine to build muscle for those who have wasting illnesses. They're used to replace testosterone in men with a testosterone deficiency. They are illegally used by people wanting to promote muscle growth. Such use can bring on serious complications. The prostate gland might grow larger. The testicles can shrink. Breasts tend to enlarge. Hair can be lost. Inappropriate aggression often results. They are not miracle workers. Q.I underwent a complete and thorough CT body scan, which indicated no evidence of cancer. However, this line on the report confuses me: "There is calcification of the coronary arteries, mostly involving the left anterior descending artery and to a lesser degree the right coronary and circumflex arteries. Atherosclerotic calcifications of the abdominal aorta is also noted." This is all news to me. I have no aches, pains or blood pressure problems. What is my prognosis? Should I be concerned? I am past 75. A.What kind of CT scan did you have? If it was an ordinary one, what was mentioned on the report could be said of most people in their 70s. Just about everyone at that age has some calcification of their heart arteries and of their aorta. It happens with age. If the scan was an ultrafast CT scan (an electron beam or helical scan), the amount of calcification in arteries is quantified by using the Agatston score. Calcium is part of artery plaque -- the buildup of cholesterol, fat and many other materials clinging to and invading artery walls. It's the stuff that can lead to obstruction of blood flow to heart muscle and a heart attack. An Agatston score of less than 10 indicates minimal calcium; one of 11 to 99, moderate calcium; 100 to 399, "increased" calcium; one of more than 400, extensive calcium. Only a few people with calcium in their arteries actually have a heart attack. Furthermore, the scan doesn't disclose "vulnerable" plaque, the kind that's easily shattered and brings on an artery blockage. You paid good money to have the scan. That money entitles you to question the doctor who wrote the report and demand to know exactly what was meant by the description given on your report. Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.